How to get adult therapy without insurance

This guide is for adults paying for occupational, physical or speech therapy without insurance, or whose plan leaves that therapy out, and for family helping them. Ask every clinic for a written good faith estimate, ask nonprofit hospitals for their financial assistance policy, check health centers and university clinics, and check whether another program can pay.

If the therapy is for a child, the free and low-cost routes are different and are covered in the children’s guide to therapy without insurance; everything below is about adults.

Where should an adult without insurance start looking for therapy?

Start with one sentence that names the therapy you need and why, because every clinic and program below sorts callers by service before it talks about cost. "I need speech therapy after a stroke" or "I need physical therapy to walk safely after knee surgery" tells the person answering where to send you.

Ask for the therapy that matches the problem. Physical therapists treat movement problems arising from the muscles and bones, heart and lungs, nervous system or skin; occupational therapists work on self-care, work and leisure; speech-language pathologists treat speech, language, voice, swallowing and cognitive-communication problems.⁠^14,19 If symptoms are new or getting worse, ask a doctor or nurse what care you need and how soon; this guide is about planned therapy, not urgent care.

How do you get a written price before paying for therapy yourself?

Ask the clinic for a good faith estimate: under the No Surprises Act rules, a licensed provider must give one in writing to a patient who is uninsured, or insured but not using the plan for this therapy.⁠¹ You count as uninsured if you have no benefits for the service under a group health plan, an insurer’s policy, a federal health care program or the federal employees’ plan; you count as self-pay if you have a group plan, an insurer’s policy or the federal employees’ plan and choose not to have a claim sent.⁠¹ The self-pay case does not name Medicare or Medicaid, so if either covers the therapy, declining to bill it does not bring you under this rule; the Medicare therapy coverage guide covers paying privately with Medicare.⁠^1,22,23

What the clinic owes you:

• It must tell you about the estimate out loud when you book or ask about cost, and post the information on its website and in the office.⁠¹
• Any discussion of, or question about, the cost of a service you are considering counts as a request.⁠¹
• After a request, the estimate is due within 3 business days; after you book, within 1 business day for a visit 3 to 9 business days away, or 3 business days for one 10 or more away, and a visit booked 0 to 2 business days ahead carries no right to one.⁠^1,24
• It must be written, on paper or electronically as you prefer, and it lists the clinic’s cash rate with any self-pay discount.⁠¹

Therapy usually means a series of visits, and one estimate can cover recurring visits for up to 12 months if it states the expected timeframe, frequency and total number.⁠¹ Ask for that version after the evaluation; it is not a contract and does not commit you to booking.⁠¹ CMS notes that an estimate may leave out care scheduled separately, such as physical therapy after surgery, so ask each clinic for its own, and compare them with the physical therapy cost guide or the adult occupational therapy cost guide.⁠²⁴

What can you do if a therapy bill is $400 more than the estimate?

You can ask HHS for patient-provider dispute resolution when one provider’s total bill is at least $400 more than that provider’s total on the estimate, postmarked within 120 calendar days of the first bill with the higher charges.⁠² The fee is $25, non-refundable, and comes off what you owe if you win; CMS adds that you cannot dispute without the estimate, and that disputing does not raise your costs.⁠^3,24 While the dispute is open, the provider must not send the bill to collections, must pause late fees and must not retaliate.⁠² CMS’s No Surprises Help Desk is at 1-800-985-3059.⁠²⁴

Can a nonprofit hospital’s financial assistance pay for outpatient therapy?

It can, when the therapy is care the hospital facility provides: every tax-exempt hospital organization must have a written financial assistance policy covering all emergency and other medically necessary care the hospital facility provides.⁠^4,5

Buildings run under one state hospital license count as one hospital facility, so an outpatient rehabilitation department under the hospital’s license is part of it.⁠²⁵ The policy must state who is eligible and whether help means free or discounted care, how charges are calculated, how to apply, and which other providers delivering care in the hospital it covers, which shows whether your therapist’s bill is included.⁠⁴

Once you are found eligible, the hospital may not charge you more than it generally bills insured patients for that care, but it can also offer discounts outside the policy that are not held to that limit, so ask which kind you are offered.⁠^5,25 The hospital must mail the policy free on request, give its web address to anyone who asks and print a notice about it on bills, and it may not deny help because you left out information the form never asked for.⁠⁵ You can apply after the care: the application period runs at least 240 days from the first billing statement, and a hospital may accept later applications.⁠²⁵

The rule binds hospital organizations recognized under section 501(c)(3), not for-profit hospitals or private practices, though CMS notes that other places may still offer financial assistance.⁠^25,26 About 127 facilities also still owe free or reduced-cost care under the older Hill-Burton program, free at or below the federal poverty guidelines and reduced up to twice them; you apply at the admissions or business office, before or after care, and it covers facility costs, not private doctors’ bills.⁠²⁷

What should you ask a hospital’s financial assistance office?

Ask for the documents by name, and keep copies of everything you send.

If a bill is already with a collector, CMS suggests telling the collector you are applying and asking it to pause.⁠²⁶

Do community health centers offer PT, OT or speech therapy on a sliding scale?

Some do, but none has to: HRSA lists occupational therapy, physical therapy and speech-language pathology among the additional services a health center may provide rather than the required ones, and each center’s board decides which to offer.⁠^7,8

Every health center adjusts fees to income and family size and must not deny service to anyone who cannot pay.⁠^6,28 Its sliding fee discounts follow federal rules:⁠²⁸

• At or below 100 percent of the federal poverty guidelines: a full discount, or a small nominal charge.⁠²⁸
• Above 100 percent and up to 200 percent: partial discounts that step down as income rises.⁠²⁸
• Above 200 percent: no sliding fee discount.⁠²⁸

If a center includes therapy in its approved services, that therapy must be open to all patients and discounted on the sliding scale.⁠⁷ A center may provide it directly, by contract or by formal referral, and not every site offers every service; under a formal referral, patients at or below the poverty guidelines still get a full discount or a nominal charge.⁠^7,8,28 HRSA’s Find a Health Center tool searches by city, state or ZIP code, and many centers can help with transportation.⁠^6,29

How do university OT, PT and speech training clinics work?

A university training clinic is a teaching clinic where students in a degree program evaluate and treat patients under licensed clinicians’ supervision, and each program sets its own services, fees and calendar. The University of Washington Speech & Hearing Clinic shows how one runs; it is an example, not a rule for others:⁠³⁰

• Master’s students provide speech-language pathology under clinical educators certified by ASHA and licensed by Washington.⁠^20,30
• Its speech-language pathology services are pro bono, supported by donations, and it bills no insurer, Medicare or Medicaid.⁠²⁰
• It sees people without a referral, except for some voice services.⁠²⁰
• It closes for university breaks, may keep a waiting list, and matches patients with its students’ training, so a supervisor may suggest another clinic.⁠²⁰
• Adult services include aphasia, cognitive-communication problems after a stroke or brain injury, and motor speech and voice disorders.⁠³¹

To find a program, start with the accrediting bodies’ lists: CAPTE’s directory of physical therapist and assistant programs, ACOTE’s directory of occupational therapy programs, and ASHA’s EdFind, which covers more than 300 institutions with speech-language pathology and audiology programs.⁠^32,33,34 Then check the program’s website for a clinic, or call the department and ask whether it sees adults for your problem, who supervises, what the evaluation and visits cost, when the next term starts, and whom it suggests if it cannot take you.

Could you qualify for Medicaid or a Marketplace plan instead?

Check before you settle on paying yourself: you can apply for Medicaid at any time of year, and HealthCare.gov’s open enrollment for 2027 coverage begins November 1, 2026.⁠^9,10 Until coverage is confirmed with a start date, budget as if you are paying yourself.

Who qualifies for Medicaid as an adult under 65?

In states that expanded Medicaid, adults qualify on income alone below 133 percent of the federal poverty level, which works out to 138 percent; a few states use a different limit, and in every state people can also qualify through disability, family status and other factors.⁠³⁵ HealthCare.gov warns that a recent law change limits full Medicaid to certain immigration statuses, such as lawful permanent residents.⁠⁹ If you had therapy before applying, ask about those months: HealthCare.gov states that Medicaid may be able to help pay for care from the last 3 months, depending on income and medical expenses at the time.⁠⁹

Does adult Medicaid pay for physical, occupational and speech therapy?

It depends on your state and how you qualify. In a state’s regular Medicaid plan, physical therapy, occupational therapy and speech, hearing and language services are optional benefits each state chooses whether to add.⁠²¹ Adults covered through Medicaid expansion receive an Alternative Benefit Plan that must include the ten essential health benefits, among them rehabilitative and habilitative services and devices.⁠^21,36,37 Ask your state agency, or the plan it assigns, which therapy it covers.

When can you buy a Marketplace plan that covers therapy?

HealthCare.gov’s open enrollment runs from November 1, 2026, to January 15, 2027: enroll by December 15 for coverage from January 1, or by January 15 for coverage from February 1.⁠¹⁰ Outside that window you need a Special Enrollment Period, usually after a life change in the past 60 days such as losing other coverage, marrying or moving to a new ZIP code or county; losing Medicaid opens a 90-day window, and you may have to send documents.⁠³⁸ If your state runs its own marketplace, check its dates.

Every Marketplace plan covers rehabilitative and habilitative services and devices, which help people with injuries, disabilities or chronic conditions gain or recover skills; specifics vary by state, and deductibles and copayments generally apply.⁠³⁹ That benefit rule is written for non-grandfathered coverage in the individual and small group markets, so if a large employer’s plan leaves therapy out, its own documents decide.⁠³⁷

What can pay for therapy besides health insurance?

Programs tied to a cause or goal can pay: workers’ compensation for a work injury, auto insurance after a crash, vocational rehabilitation for a job goal, the VA for veterans, and Medicare after Social Security disability.⁠^{11,12,13,14,15}

Does workers’ compensation pay for therapy after a work injury?

It can, through the system that covers your job. The U.S. Department of Labor directs people hurt working for a private company or a state or local government to their state workers’ compensation board; its own office runs four programs for federal workers and certain other groups, providing medical treatment, wage replacement and vocational rehabilitation.⁠¹¹ Ask the claim handler how therapy is approved before you book, and tell the clinic it is a work injury.

Can car insurance pay for therapy after an accident?

Sometimes, depending on your state and policy. Some states require medical payments coverage, which helps pay for an injured driver’s or passengers’ treatment, or personal injury protection, which covers medical bills and lost wages; an at-fault driver’s bodily injury liability coverage pays other people’s medical expenses.⁠¹² Read your declarations page and ask the insurer where therapy bills should go before the first visit.

Can a state vocational rehabilitation agency pay for therapy?

It can, when therapy is part of a plan to get or keep a job. Vocational rehabilitation serves people whose impairment is a substantial barrier to employment and who need services to work, with priority for the most significant disabilities when an agency cannot serve everyone.⁠⁴⁰ Its physical and mental restoration services include physical therapy, occupational therapy, speech or hearing therapy, and prosthetic and orthotic devices.⁠¹³ They follow your individualized plan for employment and are paid when support is not readily available elsewhere, such as from health insurance.⁠⁴¹ No federal rule requires a financial needs test; a state may set one, but your share must not effectively deny you a needed service.⁠⁴² RSA lists all 78 state agencies.⁠⁴³

Does the VA cover physical, occupational or speech therapy?

Yes, for veterans who qualify for VA health care. VA rehabilitation services provide occupational and physical therapy in outpatient clinics, inpatient settings, telemedicine and veterans’ homes, and VA speech-language pathologists treat speech, swallowing, language, voice and cognitive-communication disorders.⁠^14,19 You may be eligible if you served in the active military, naval or air service without a dishonorable discharge; most who enlisted after September 7, 1980, also face a minimum service rule.⁠⁴⁴

Can Social Security disability lead to Medicare coverage for therapy?

Yes: Social Security enrolls you in Medicare automatically 2 years after you became entitled to disability benefits, or at once if you have ALS.⁠¹⁵ Supplemental Security Income alone does not qualify you.⁠⁴⁵ Medicare Part B helps pay for medically necessary outpatient physical, occupational and speech therapy, and the Medicare therapy coverage guide explains what you pay.⁠^16,46,47 Your local SHIP gives free one-on-one Medicare counseling.⁠⁴⁸

How do you pay a therapy clinic directly without overpaying?

Get the clinic’s self-pay rate in writing, and if a plan might apply, ask the plan for its allowed amount too, because those are two different numbers. On a good faith estimate, a self-pay patient’s charge is the clinic’s cash rate with any self-pay discount.⁠¹ A plan’s allowed amount is the most it pays for a covered service, also called the negotiated rate, and if a provider charges more, you may owe the difference.⁠⁴⁹ If you have a plan but have not met the deductible, ask the plan whether a cash visit counts toward it, and compare both totals over the whole course of care.

Can you look up a hospital’s cash price for therapy?

Yes, for a hospital outpatient department: every hospital must publish online its standard charges for all items and services, including a discounted cash price, the charge for someone paying cash, and the rate negotiated with each payer.⁠^50,51 The file is long and coded, so ask the billing office to point you to the lines for therapy evaluations and visits. At a private practice, the good faith estimate is your written price.

Do sliding scales, payment plans and visit packages lower the cost?

A sliding scale or discount lowers what you owe; a payment plan only spreads it out. CMS notes that hospitals and medical offices can sometimes lower the price and may offer payment plans, so ask about both and get the terms in writing.⁠²⁶ Before buying a package of visits, ask what happens to unused visits if your plan of care (the written treatment plan your therapist sets after the evaluation) changes, and buy no more visits than it calls for. Ask your therapist which parts you can safely do at home; stopping early to save money is a decision to make together.

Can you use an HSA or FSA to pay for therapy?

Usually, when the therapy is medical treatment. IRS Publication 502 counts amounts paid for therapy received as medical treatment, for care mainly to relieve or prevent a physical or mental disability or illness.⁠⁵² HSA distributions are tax-free for qualified medical expenses incurred after you opened the account, and FSA reimbursements for them are not taxed.⁠⁵³ Money already in an HSA can be spent without a high-deductible plan, which matters only for adding new money.⁠⁵⁴

What should you ask a clinic before you pay for therapy yourself?

Ask the questions that turn a quoted rate into a total you can compare.

Do you need a doctor’s referral if you pay for therapy yourself?

It depends on the therapy and the state, not on who pays. APTA reports that as of July 1, 2025, all 50 states, the District of Columbia and the U.S. Virgin Islands allow provisional or unrestricted direct access to a physical therapist for evaluation and treatment, but some states still attach conditions to treatment without a referral.⁠¹⁷ Those conditions differ by state and are written into each state’s practice act, the law that licenses physical therapists, so paying out of pocket does not set them aside.⁠¹⁸

Occupational therapists are licensed in all 50 states and the District of Columbia, and each state’s licensing agency regulates their practice, so ask the clinic whether your state requires a referral before an evaluation.⁠⁵⁵ For speech therapy, ask as well; the University of Washington clinic, for one, sees people without a referral except for some voice services.⁠²⁰ A program that pays can add its own rule: Medicaid defines physical and occupational therapy as services prescribed, and speech services as services referred, by a physician or other licensed practitioner.⁠⁵⁶ If Medicaid or Medicare may start paying partway through, ask the clinic to set up that program’s paperwork from the first visit.

How do you organize your calls and compare what you hear?

Pick the three routes from the table at the top that fit you best, call them in order, and record each answer the same way, keeping confirmed answers apart from possibilities. Send income or medical documents only by the method each organization specifies.

When you are ready to look for clinics, DrSensory’s directory is free to use and lists occupational, physical and speech therapy clinics for children and adults, which you can filter by location. It lists clinics, not individual therapists, and does not verify clinical quality, so prices, sliding scales and openings come from each clinic; take the script above into every call. For what each therapy treats in adults, see the adult therapy guides.

Sources

1. 45 CFR. §149.610, Requirements for provision of good faith estimates of expected charges for uninsured (or self-pay) individuals. Checked October 24, 2026.
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   (a)(1): estimates are owed to uninsured or self-pay individuals or their authorized representatives “upon request or upon scheduling an item or service”; (a)(2)(i): “Authorized representative means an individual authorized under State law to provide consent on behalf of the uninsured (or self-pay) individual”; (a)(2)(v): for a self-pay or uninsured person the expected charge is “the cash pay rate or rate established by a provider or facility for an uninsured (or self-pay) individual, reflecting any discounts for such individuals”; (a)(2)(viii): “Health care provider (provider) means a physician or other health care provider who is acting within the scope of practice of that provider’s license or certification under applicable State law”; (a)(2)(xiii)(A): an uninsured individual is “An individual who does not have benefits for an item or service under a group health plan”, individual or group coverage from an insurer, a “Federal health care program (as defined in section 1128B(f) of the Social Security Act)” or the federal employees’ plan; (a)(2)(xiii)(B), the self-pay prong, names a group health plan, individual or group coverage from an insurer “or a health benefits plan under chapter 89 of title 5, United States Code but who does not seek to have a claim for such item or service submitted to such plan or coverage”, and does not name a Federal health care program; (b)(1)(i): the provider determines status by “Inquiring if an individual is enrolled in a group health plan”; (b)(1)(iii): information about the estimate must be “prominently displayed (and easily searchable from a public search engine) on the convening provider’s or convening facility’s website, in the office, and on-site where scheduling or questions about the cost of items or services occur” and “Orally provided when scheduling an item or service or when questions about the cost of items or services occur”; (b)(1)(iv): “Convening providers and convening facilities shall consider any discussion or inquiry regarding the potential costs of items or services under consideration as a request for a good faith estimate”; (b)(1)(vi): “When a primary item or service is scheduled at least 3 business days before the date the item or service is scheduled to be furnished: Not later than 1 business day after the date of scheduling”; “When a primary item or service is scheduled at least 10 business days before such item or service is scheduled to be furnished: Not later than 3 business days after the date of scheduling”; “When a good faith estimate is requested by an uninsured (or self-pay) individual: Not later than 3 business days after the date of the request.” (b)(1)(x): a single estimate for recurring services must state “the expected scope of the recurring primary items or services (such as timeframes, frequency, and total number of recurring items or services)” and “The scope of a good faith estimate for recurring primary items or services must not exceed 12 months.” (c)(1)(xi): “A disclaimer that the good faith estimate is not a contract and does not require the uninsured (or self-pay) individual to obtain the items or services from any of the providers or facilities identified in the good faith estimate.” (e)(1): “A good faith estimate must be provided in written form either on paper or electronically, pursuant to the uninsured (or self-pay) individual’s requested method of delivery”; (e)(2): after any oral explanation, the provider “must issue the good faith estimate to the uninsured (or self-pay) individual in written form”; (f)(1): “Convening providers and convening facilities must provide a copy of any previously issued good faith estimate furnished within the last 6 years to an uninsured (or self-pay) individual upon the request of the uninsured (or self-pay) individual.” Text as published in the eCFR, current through October 22, 2026.
2. 45 CFR. §149.620, Requirements for the patient-provider dispute resolution process. Checked October 24, 2026.
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   (a)(2)(ii): “Substantially in excess means, with respect to the total billed charges by a provider or facility, an amount that is at least $400 more than the total amount of expected charges listed on the good faith estimate for the provider or facility.” (c)(1): the individual starts the process by a notice to HHS “postmarked within 120 calendar days of receiving the initial bill containing charges for the item or service that is substantially in excess of the expected charges in the good faith estimate”; (c)(5): “While the patient-provider dispute resolution process is pending, the provider or facility must not move the bill for the disputed item or service into collection or threaten to do so”, and “must also suspend the accrual of any late fees on unpaid bill amounts until after the dispute resolution process has concluded”; (c)(6): the provider “must not take or threaten to take any retributive action against an uninsured (or self-pay) individual for utilizing the patient-provider dispute resolution process”. Text as published in the eCFR, current through October 22, 2026.
3. Centers for Medicare & Medicaid Services. Dispute a medical bill (medical bill rights, page last modified October 2, 2026). Checked October 24, 2026.
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   You can dispute a bill only if, among other conditions, “Before you got care, you told your provider that you weren’t using insurance to pay for it.”; “You have an initial bill dated within the last 120 calendar days (about 4 months).”; “One of your providers or facilities charged at least $400 more than their good faith estimate.”; “$25 non-refundable administrative fee”; “If the dispute is decided in your favor, the $25 will be deducted from the amount you owe your provider.”; “No matter the outcome, your costs won’t increase if you dispute your bill.”
4. 26 CFR. §1.501(r)-4, Financial assistance policy and emergency medical care policy. Checked October 24, 2026.
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   (b)(1): a hospital facility’s FAP must “Apply to all emergency and other medically necessary care provided by the hospital facility, including all such care provided in the hospital facility by a substantially-related entity” and include “The eligibility criteria for financial assistance and whether such assistance includes free or discounted care”; “The basis for calculating amounts charged to patients”; “The method for applying for financial assistance”; and “A list of any providers, other than the hospital facility itself, delivering emergency or other medically necessary care in the hospital facility that specifies which providers are covered by the hospital facility’s FAP and which are not.” Text as published in the eCFR, current through October 22, 2026.
5. Internal Revenue Service. Financial assistance policy and emergency medical care policy – Section 501(r)(4). Checked October 24, 2026.
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   “Section 501(r)(4) requires a hospital organization to establish a written financial assistance policy (FAP) and a written emergency medical care policy for a hospital facility it operates.”; “A FAP must apply to all emergency and other medically necessary care provided by the hospital facility, including all such care provided in the hospital facility by a substantially-related entity.”; “a FAP-eligible individual may not be charged more than Amounts Generally Billed (AGB) for emergency or medically necessary care”; “Hospital facilities may offer payment discounts or other discounts outside of their FAPs and may charge discounted amounts greater than AGB to individuals that are not FAP-eligible.”; “Financial assistance may not be denied based on the omission of information or documentation if the information or documentation was not specifically required by the FAP or FAP application form.”; the hospital facility must publicize the policy by “Making paper copies of the FAP documents available upon request and without charge by mail and in public locations in the hospital facility”, and “The hospital facility must provide any individual who asks how to access a copy of the FAP documents with the direct Website address, or URL, of the web page on which these documents are available.” Billing statements must carry “a conspicuous written notice on billing statements that notifies and informs recipients about availability of financial assistance under the FAP”.
6. Health Resources and Services Administration, Bureau of Primary Health Care. What is a Health Center? (date last reviewed November 2025). Checked October 24, 2026.
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   All health centers “Adjust their fees based on income and family size”; health centers must “Serve everyone, even if they cannot pay”; many health centers “Can help with transportation if patients have trouble getting to a clinic”; “Use the Find a Health Center tool to locate a health center clinic near you.”
7. Health Resources and Services Administration, Bureau of Primary Health Care. Service Descriptors for Form 5A: Services Provided (PDF, last updated April 2026). Checked October 24, 2026.
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   “Health centers may also provide additional health services, beyond those required by statute or regulations, as appropriate to meet the needs of the population served by the health center”; “not all services must be available at every health center service site”; “Once a service is included in the approved scope of project, it must be available to all patients regardless of ability to pay and be discounted in accordance with the health center’s sliding fee discount program.” Occupational Therapy, Physical Therapy and Speech-Language Pathology/Therapy are listed under “ADDITIONAL SERVICES”, not “REQUIRED SERVICES”: “Occupational therapy services provide assessment and treatment services to assist patients in their ability to perform activities of daily living.”; “Physical therapy services provide assessment and treatment services to assist patients to maintain, restore, and improve physical activity and functioning while ensuring safety.”; “Speech-language pathology/therapy services provide assessment and treatment services to assist patients to improve and optimize their ability to communicate and swallow.”
8. Health Resources and Services Administration, Bureau of Primary Health Care. Health Center Program Compliance Manual, Chapter 4: Required and Additional Health Services. Checked October 24, 2026.
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   “The health center governing board determines which, if any, additional health services to offer in order to meet the health needs of the population served by the health center (subject to review and approval by HRSA).” Services are provided “directly, or through written contracts and/or cooperative arrangements (which may include formal referrals)”.
9. HealthCare.gov. Medicaid & CHIP coverage. Checked October 24, 2026.
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   “You can apply for Medicaid and CHIP any time of year.” “Medicaid programs must follow federal guidelines, but eligible income levels, coverage, and costs may be different from state to state.” “Medicaid may be able to help you pay for medical care from the last 3 months, even if you weren’t enrolled in Medicaid at the time you got medical care. Payment depends on your family’s income and medical expenses at the time.” The page’s warning: “Due to a law change, only people with the following immigration statuses are now eligible for full” Medicaid or CHIP coverage, beginning with “Lawful Permanent Resident (LPR, Green Card holder)”.
10. HealthCare.gov. When can you get health insurance? (a quick guide to the Health Insurance Marketplace). Checked October 24, 2026.
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    “Starting November 1, you can apply for 2027 coverage or update your application with any changes you expect for the year ahead.” “December 15: Last day to enroll in or change plans for coverage to start January 1.” “January 15: Open Enrollment ends — last day to enroll in or change Marketplace health plans for the year.” “February 1: Coverage starts for those who enroll in or change plans December 16 through January 15 and pay their first premium.”
11. U.S. Department of Labor. Workers’ Compensation. Checked October 24, 2026.
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    “The U.S. Department of Labor’s Office of Workers’ Compensation Programs (OWCP) administers four major disability compensation programs” for federal workers and other specific groups, providing “Wage replacement benefits”, “Medical treatment”, “Vocational rehabilitation”; “Individuals injured on the job while employed by private companies or state and local government agencies should contact their state workers’ compensation board.”
12. National Association of Insurance Commissioners. Auto Insurance (insurance topics). Checked October 24, 2026.
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    “Some states also require coverage for medical payments, to help pay for treatment for injured driver and/or passengers, and/or personal injury protection (PIP), which covers medical bills, lost wages, or funeral expenses.” “Bodily injury – covers medical expenses for other people injured in an accident caused by the insured driver.”
13. 34 CFR. §361.5, Applicable definitions (State Vocational Rehabilitation Services program). (c)(39): “Physical and mental restoration services means”, among others, “(vii) Prosthetic and orthotic devices;” “(x) Physical therapy;” “(xi) Occupational therapy;” “(xii) Speech or hearing therapy;” Text as published in the eCFR, current through October 22, 2026. Checked October 24, 2026.
14. U.S. Department of Veterans Affairs, Rehabilitation and Prosthetic Services. VHA Physical Medicine and Rehabilitation Services (PM&RS). Checked October 24, 2026.
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    Occupational therapy “Provides goal-directed treatment utilizing a variety of techniques and activities to improve functional daily skills”; “Occupational Therapists provide evaluation and treatment in areas of self-care, work, productive/leisure activities to achieve participation in their everyday life occupations.” “Physical therapists treat Veterans with movement disorders which include impairments of the musculoskeletal, cardiovascular/pulmonary, neuromuscular and integumentary (skin) systems.” “Patients throughout the continuum of care settings often need rehabilitation services, including outpatient clinics, inpatient settings, telemedicine and Veteran’s homes.”
15. Social Security Administration. What you could get from Disability. Checked October 24, 2026.
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    “We’ll automatically enroll you in Medicare 2 years after the date you became entitled to Disability.” “You’ll get a welcome package in the mail 3 months before your coverage starts.” “If you have ALS (Lou Gehrig’s disease), you can get Medicare as soon as you become entitled to Disability.”
16. Medicare.gov (Centers for Medicare & Medicaid Services). Physical therapy services (your Medicare coverage). “Medicare Part B (Medical Insurance) helps pay for medically necessary outpatient physical therapy, if you’re eligible”. Checked October 24, 2026.
17. American Physical Therapy Association. Direct Access Advocacy. Checked October 24, 2026.
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    “As of July 1, 2025, all 50 states, the District of Columbia, and the U.S. Virgin Islands have either provisional or unrestricted direct access to physical therapist services for evaluation and treatment.” “Even though patients may go directly to a physical therapist without a referral, some provisions tied to treatment absent a referral still persist in a number of states”.
18. American Physical Therapy Association. Direct Access By State. Checked October 24, 2026.
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    “While all 50 states, the District of Columbia and the U.S. Virgin Islands, provide some form of direct access to physical therapist services, the specific provisions and limitations differ across jurisdictions.” The summary covers “the language (if any) regarding direct access in each state’s practice act”; “Please note that the data below is current as of July 2025.”
19. U.S. Department of Veterans Affairs, Rehabilitation and Prosthetic Services. VA Speech-Language Pathology. “The Department of Veterans Affairs (VA) offers comprehensive speech-language pathology services to Veterans and Servicemembers.” “Speech-language pathology services include the early identification or screening, evaluation, and treatment for speech, swallowing, language, voice and cognitive- communication disorders.” Checked October 24, 2026.
20. University of Washington, Department of Speech and Hearing Sciences. Clinic FAQ (UW Speech & Hearing Clinic). Checked October 24, 2026.
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    “You can be seen at the clinic without having a referral from an outside clinic or doctor’s office.” “Some voice services require referral.” “Speech-language pathology services are pro-bono and supported by donations.” “The clinic is open during the four academic quarters of the year, and closed for holidays and vacation breaks observed by the University of Washington.” “Depending upon the services you are seeking there may be a waiting list.” “We are an outpatient teaching clinic whose speech-language pathology clinical services are provided by our master’s graduate students under the supervision of our clinical faculty.” “We make every effort to match your evaluation and treatment needs with the educational needs of our students.” “In some cases, the clinical supervisor may recommend that your specific needs would be better served elsewhere in the community”; “At this time we do not bill insurance companies or Medicare/Medicaid.”
21. Medicaid.gov (Centers for Medicare & Medicaid Services). Mandatory & Optional Medicaid Benefits. Checked October 24, 2026.
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    “States are required to provide all mandatory benefits under federal law. States may provide optional benefits if they choose to add them through the state plan process.” Listed under Optional Benefits: “Physical therapy (1905(a)(11), 42 CFR 440.110(a))”; “Occupational therapy (1905(a)(11), 42 CFR 440.110(b))”; “Speech, hearing and language disorder services (1905(a)(11), 42 CFR 440.110(c))”; “The ABP is mandatory for the Medicaid expansion population.”
22. Social Security Administration. Social Security Act §1128B (compilation of the Act). Checked October 24, 2026.
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    (f): “the term ‘Federal health care program’ means—” “(1) any plan or program that provides health benefits, whether directly, through insurance, or otherwise, which is funded directly, in whole or in part, by the United States Government (other than the health insurance program under chapter 89 of title 5, United States Code”); or “(2) any State health care program, as defined in section 1128(h).”
23. Social Security Administration. Social Security Act §1128 (compilation of the Act). (h): “the term ‘State health care program’ means—” “(1) a State plan approved under title XIX,” (title XIX of the Act is Medicaid). Checked October 24, 2026.
24. Centers for Medicare & Medicaid Services. What is a good faith estimate? (medical bill rights, page last modified October 5, 2026). Checked October 24, 2026.
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    “Usually, if you aren’t using health insurance to pay for your care, your health care provider must give you a good faith estimate of expected charges if you request one or schedule services at least 3 business days in advance.”; “When you schedule care 0-2 business days in advance, you aren’t entitled to get a good faith estimate.”; “You can ask your provider for an estimate before you schedule care. They must give it to you within 3 business days.”; an estimate might not include “Items or services related to your care that are scheduled separately, like pre-surgery appointments, or physical therapy in the weeks after surgery.”; “You can’t dispute your bill without an estimate.”; “Call our Help Desk at 1-800-985-3059.”
25. 26 CFR. §1.501(r)-1, Definitions. Checked October 24, 2026.
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    (b)(1): “Amounts generally billed (AGB) means the amounts generally billed for emergency or other medically necessary care to individuals who have insurance covering such care”; (b)(3): the application period “begins on the date the care is provided and ends on the later of the 240th day after the date that the first post-discharge billing statement for the care is provided”, and “A hospital facility may accept and process an individual’s FAP application submitted outside of the application period.” (b)(17): “Hospital facility means a facility that is required by a state to be licensed, registered, or similarly recognized as a hospital. Multiple buildings operated under a single state license are considered to be a single hospital facility.” (b)(18): “Hospital organization means an organization recognized (or seeking to be recognized) as described in section 501(c)(3) that operates one or more hospital facilities.” Text as published in the eCFR, current through October 22, 2026.
26. Centers for Medicare & Medicaid Services. Apply for medical bill financial assistance (medical bill rights, page last modified October 5, 2026). Checked October 24, 2026.
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    “Nonprofit hospitals must give financial assistance to eligible patients who can’t afford to pay.”; “If you got care elsewhere, they may still offer financial assistance.”; after you apply, ask the hospital “How long it takes to process your application for financial assistance” and “What happens with your bill in the meantime”; if a bill is in collections, tell debt collectors you are seeking help: “Ask them to pause collections while that process plays out.”; “Hospitals and medical offices can sometimes lower the price. They may also offer payment plans.”
27. Health Resources and Services Administration. Hill-Burton Free and Reduced-Cost Health Care. Checked October 24, 2026.
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    “about 127 health care facilities nationwide are still obligated to provide free or reduced-cost care”; “You are eligible to apply for Hill-Burton free care if your income is at or below the current Federal Poverty Guidelines.”; “You may be eligible for Hill-Burton reduced-cost care if your income is as much as two times (triple for nursing home care) the HHS Poverty Guidelines.”; “You must apply at the admissions or business office at an obligated facility and be found eligible to receive free or reduced-cost care. You may apply before or after you receive care”; “Only facility costs are covered, not your private doctors’ bills.”; the facility must give you “a written statement that tells you what free or reduced-cost care services you will get or why you have been denied”; Hill-Burton Hotline “1-800-638-0742”.
28. Health Resources and Services Administration, Bureau of Primary Health Care. Health Center Program Compliance Manual, Chapter 9: Sliding Fee Discount Program. Checked October 24, 2026.
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    “The health center must operate in a manner such that no patient shall be denied service due to an individual’s inability to pay.” Policies cover “Assessment of all patients for sliding fee discount eligibility based only on income and family size”; “A full discount is provided for individuals and families with annual incomes at or below 100 percent of the current FPG, unless a health center elects to have a nominal charge”; “Partial discounts are provided for individuals and families with incomes above 100 percent of the current FPG and at or below 200 percent of the current FPG, and those discounts adjust based on gradations in income levels and include at least three discount pay classes.”; “No discounts are provided to individuals and families with annual incomes above 200 percent of the current FPG.” “The health center determines how to document income and family size in health center records.” A center may “permit self-declaration of income and family size”, and “The health center determines whether to identify individuals who refuse to provide information on income and family size as ineligible for SFDS.” For services provided via formal referral arrangements, the center ensures the fees are discounted so that “Individuals and families at or below 100 percent of the FPG receive a full discount or a nominal charge for these services.”
29. Health Resources and Services Administration. Find a Health Center (search tool). The tool’s search criteria: “Search by City, State, or Zip”. Checked October 24, 2026.
30. University of Washington, Department of Speech and Hearing Sciences. UW Speech & Hearing Clinic. “Graduate students provide services under the close supervision of clinical educators who are experts in their field, nationally certified by the American Speech-Language Hearing Association (ASHA), and licensed by the Washington Department of Health.” Checked October 24, 2026.
31. University of Washington, Department of Speech and Hearing Sciences. Speech & Language Services (UW Speech & Hearing Clinic). Checked October 24, 2026.
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    “UW Speech & Hearing Clinic provides comprehensive speech and language services grounded in evidence-based practice, clinical expertise, and patient-centered care across the lifespan.” Services listed include aphasia, cognitive-communication deficits, which “Result from neurological conditions such as TBI, stroke, brain tumor, and other acquired conditions”, motor speech disorders and voice disorders; “We currently only treat children and teens with speech sound disorders.”
32. Commission on Accreditation in Physical Therapy Education. Directory of Physical Therapy Programs. “Access the directory of accredited physical therapist and physical therapist assistant education programs”. Checked October 24, 2026.
33. Accreditation Council for Occupational Therapy Education. Schools. “The Accreditation Council for Occupational Therapy Education (ACOTE®) is the accrediting agency for entry-level educational programs for the occupational therapist and occupational therapy assistant.” The page links a “School Directory- United States”. Checked October 24, 2026.
34. American Speech-Language-Hearing Association. ASHA EdFind (a directory of graduate programs in speech-language pathology and audiology). “There are over 300 institutions offering degree programs in audiology, speech-language pathology, and speech, language, and hearing science available in EdFind.” Checked October 24, 2026.
35. HealthCare.gov. Medicaid expansion & what it means for you. Checked October 24, 2026.
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    “In states that have expanded Medicaid coverage: You can qualify based on your income alone. If your household income is below 133% of the federal poverty level (FPL), you qualify. (Because of the way this is calculated, it turns out to be 138% of the federal poverty level. A few states use a different income limit.)” “In all states: You can qualify for Medicaid based on income, household size, disability, family status, and other factors. Eligibility rules differ between states.” “You can get care at a nearby community health center. These centers provide services on a sliding scale based on your income.”
36. Medicaid.gov (Centers for Medicare & Medicaid Services). Alternative Benefit Plan Coverage. Checked October 24, 2026.
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    “Alternative Benefit Plans (ABP) must cover the 10 Essential Health Benefits (EHB) as described in section 1302(b) of the Affordable Care Act whether the state uses an ABP for Medicaid expansion or coverage of any other groups of individuals.” “Individuals in the adult VIII eligibility group will receive benefits through an ABP.”
37. Centers for Medicare & Medicaid Services. Essential Health Benefits (Marketplace resources). “The Affordable Care Act requires non-grandfathered” coverage “in the individual and small group markets to cover essential health benefits (EHB)”, in ten categories including “(7) rehabilitative and habilitative services and devices”. Checked October 24, 2026.
38. HealthCare.gov. Special Enrollment Periods. Checked October 24, 2026.
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    “You may qualify for a Special Enrollment Period if you or anyone in your household lost qualifying health coverage in the past 60 days OR expects to lose coverage in the next 60 days.” “(If you lost Medicaid or Children’s Health Insurance Program (CHIP) coverage in the past 90 days, you may qualify for a Special Enrollment Period.)” Changes in household within the past 60 days include “Got married.”; a move to “A new home in a new ZIP code or county”; “If you don’t provide acceptable documents about losing coverage, you won’t qualify for a Special Enrollment Period.”
39. HealthCare.gov. What Marketplace health insurance plans cover. Checked October 24, 2026.
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    “All plans offered in the Marketplace cover these 10 essential health benefits”, among them “Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)”; “Specific services covered in each broad benefit category can vary based on your state’s requirements.”; to “Do I have to pay deductibles and copayments for essential health benefits?” the answer is “Generally, yes.”
40. Rehabilitation Services Administration, U.S. Department of Education. State Vocational Rehabilitation Services Program. Checked October 24, 2026.
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    “State VR programs provide VR services for individuals with disabilities, consistent with their strengths, resources, priorities, concerns, abilities, capabilities, interests, and informed choice, so that they may prepare for and engage in competitive integrated employment or supported employment and achieve economic self-sufficiency.” “To be eligible for the VR program, individuals must have a physical or mental impairment that results in a substantial impediment to employment and who require and can benefit from VR services to achieve employment and maximize career goals.” “Priority must be given to serving individuals with the most significant disabilities if a State VR agency is unable to serve all eligible individuals.”
41. 34 CFR. §361.48, Scope of vocational rehabilitation services for individuals with disabilities. Checked October 24, 2026.
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    (b): services are provided “consistent with each individual’s individualized plan for employment”; (b)(5): “physical and mental restoration services, to the extent that financial support is not readily available from a source other than the designated State unit (such as through health insurance or a comparable service or benefit as defined in § 361.5(c)(10))”. Text as published in the eCFR, current through October 22, 2026.
42. 34 CFR. §361.54, Participation of individuals in cost of services based on financial need. Checked October 24, 2026.
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    “There is no Federal requirement that the financial need of individuals be considered in the provision of vocational rehabilitation services.” “The State unit may choose to consider the financial need of eligible individuals”; if it does, the individual’s share must be “Not so high as to effectively deny the individual a necessary service.” Text as published in the eCFR, current through October 22, 2026.
43. Rehabilitation Services Administration, U.S. Department of Education. State Vocational Rehabilitation Agencies. Checked October 24, 2026.
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    “RSA provides formula grants to VR agencies to administer the VR, Supported Employment, and IL-OIB programs in all 50 states, the District of Columbia, Puerto Rico, and four Territories.” “22 States have established two VR agencies: one VR agency that serves individuals who are blind or have visual impairments”; “Contact information for the 78 VR agencies is available below.”
44. U.S. Department of Veterans Affairs. Eligibility for VA health care. Checked October 24, 2026.
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    “You may be eligible for VA health care benefits if you served in the active military, naval, or air service and didn’t receive a dishonorable discharge.” For those who enlisted after September 7, 1980, or entered active duty after October 16, 1981: “You must have served 24 continuous months or the full period for which you were called to active duty, unless any of the descriptions below are true for you.”
45. Social Security Administration. Sign up for Medicare. “If you’re under age 65, you may be eligible for Medicare if you have permanent kidney failure or if you receive Disability benefits. Supplemental Security Income (SSI) does not qualify you for Medicare on its own.” Checked October 24, 2026.
46. Medicare.gov (Centers for Medicare & Medicaid Services). Occupational therapy services (your Medicare coverage). “Medicare Part B (Medical Insurance) helps pay for medically necessary outpatient occupational therapy if your doctor or other health care provider certifies you need it”. Checked October 24, 2026.
47. Medicare.gov (Centers for Medicare & Medicaid Services). Speech-language pathology services (your Medicare coverage). “Medicare Part B (Medical Insurance) covers medically necessary outpatient speech-language pathology services if you’re eligible”. Checked October 24, 2026.
48. SHIP Technical Assistance Center. Get Medicare Help from Your Local SHIP Program. “Local, one-on-one Medicare counseling from your local SHIP at no cost to you.” Checked October 24, 2026.
49. HealthCare.gov. Allowed amount (glossary). “The maximum amount a plan will pay for a covered health care service. May also be called ‘eligible expense,’ ‘payment allowance,’ or ‘negotiated rate.’” “If your provider charges more than the plan’s allowed amount, you may have to pay the difference.” Checked October 24, 2026.
50. 45 CFR. §180.50, Requirements for making public hospital standard charges for all items and services. Checked October 24, 2026.
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    (a)(1): “A hospital must establish, update, and make public a list of all standard charges for all items and services online in the form and manner specified in this section.” Text as published in the eCFR, current through October 22, 2026.
51. 45 CFR. §180.20, Definitions (hospital price transparency). Checked October 24, 2026.
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    “Discounted cash price means the charge that applies to an individual who pays cash (or cash equivalent) for a hospital item or service.” “Payer-specific negotiated charge means the charge that a hospital has negotiated with a third party payer for an item or service.” Both are among the standard charges. Text as published in the eCFR, current through October 22, 2026.
52. Internal Revenue Service. Publication 502, Medical and Dental Expenses (for use in preparing 2025 returns). “Medical care expenses must be primarily to alleviate or prevent a physical or mental disability or illness.” Therapy: “You can include in medical expenses amounts you pay for therapy received as medical treatment.” Checked October 24, 2026.
53. Internal Revenue Service. Publication 969 (2025), Health Savings Accounts and Other Tax-Favored Health Plans. Checked October 24, 2026.
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    “You can receive tax-free distributions from your HSA to pay or be reimbursed for qualified medical expenses you incur after you establish the HSA.” “For HSA purposes, expenses incurred before you establish your HSA aren’t qualified medical expenses.” “Reimbursements from an FSA that are used to pay qualified medical expenses aren’t taxed.”
54. HealthCare.gov. Health Savings Account (HSA) (glossary). “While you can use the funds in an HSA at any time to pay for qualified medical expenses, you may contribute to an HSA only if you have an HSA-eligible plan (sometimes called a High Deductible Health Plan (HDHP))”. Checked October 24, 2026.
55. American Occupational Therapy Association. State Occupational Therapy Licensure. “The ability to practice occupational therapy is regulated by state licensure agencies.” “All 50 states in the United States plus the District of Columbia, Puerto Rico, and Guam require occupational therapists and occupational therapy assistants to be licensed to provide occupational therapy services.” Checked October 24, 2026.
56. 42 CFR. §440.110, Physical therapy, occupational therapy, and services for individuals with speech, hearing, and language disorders (Medicaid). Checked October 24, 2026.
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    (a)(1) and (b)(1): physical and occupational therapy mean “services prescribed by a physician or other licensed practitioner of the healing arts within the scope of his or her practice under State law”; (c)(1): speech, hearing and language services are those “for which a patient is referred by a physician or other licensed practitioner of the healing arts within the scope of his or her practice under State law”. Text as published in the eCFR, current through October 22, 2026.
57. U.S. Department of Health and Human Services, Office for Civil Rights. Family Members and Friends (HIPAA for individuals, content last reviewed December 23, 2022). Checked October 24, 2026.
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    “The Privacy Rule does not require a health care provider or health plan to share information with your family or friends, unless they are your personal representatives.” The provider or plan can share information if “They are involved in your health care or payment for your health care”, “You tell the provider or plan that it can do so”, or “You do not object to sharing of the information”; “If you do not object, your doctor could talk with the friend who goes with you to the hospital or with a family member who pays your medical bill.”
58. Administration for Community Living. Assistive Technology. Checked October 24, 2026.
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    “The State Grant for Assistive Technology Program makes assistive technology devices and services more available and accessible to individuals with disabilities and their families.” “The program provides one grant to each state, the District of Columbia, Puerto Rico, and the outlying areas”; “Each State Grant for Assistive Technology program includes financing activities.”

Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider about your individual situation.